First Case Report of a Sporadic Adrenocortical Carcinoma With Gastric Metastasis and a Synchronous Gastrointestinal Stromal Tumor of the Stomach

Abstract

Adrenocortical carcinoma is a rare tumor with high aggresivity that can associate systemic metastases. A 71-year-old man was hospitalized for gastric cancer. The abdominal computed tomography also revealed a tumor above the right kidney. Total gastrectomy and right adrenalectomy were performed. The encapsulated tumor of the adrenal gland weighed 560 grams and presented diffuse tumor architecture under microscope, with capsular, sinusoidal, and vascular invasion. The large tumor cells had a polygonal shape, with slight basophilic, eosinophilic, or vacuolated cytoplasm, pleomorphic nuclei, and a high mitotic rate. In the stomach, the protruded tumor was covered by normal mucosa; under microscope, the tumor cells were observed only in the submucosal layer. In primary adrenal tumor and gastric metastasis the tumor cells were marked by vimentin, inhibin, synaptophysin, neuron-specific enolase, and calretinin. Based on these criteria, the diagnosis of adrenocortical carcinoma (ACC) with gastric metastasis and no lymph node metastases was established. A synchronous 10 × 10-mm-sized gastrointestinal stromal tumor (GIST) of the stomach, without mitoses, was also identified. So far, as we know, this is the 15th case of ever reported synchronous/metachronous sporadic ACCs; the ACC-related gastric metastases either synchronous ACC and GIST, has not been reported in the literature previously.

FIGURE 1

Adrenocortical carcinoma of the right adrenal gland. A, CT-scan; B, Macroscopic aspect. C–H, Microscopically, the clusters of polygonal-shaped cells with eosinophilic cytoplasm, well-defined nucleoli, and atypical mitoses (C–E) are marked by vimentin (F), neuron specific enolase (G), and synaptophysin (H).

FIGURE 2

Gastric metastasis from adrenocortical carcinoma. A,B, Macroscopically, the protruded tumor is located in the gastric body, in the submucosa. C,D, Microscopic examination shows clusters of polygonal-shaped cells with eosinophilic cytoplasm with similar aspect with the primary tumor from Figure 1. E,F, The synchronous gastrointestinal stromal tumor (GIST) of the stomach displays CD34.